Genome wide association studies (GWAS) to date have identified 30 CAD susceptibility loci but the ability to use this information to improve risk prediction remains limited. A meta-analysis of the GWAS and Cardio Metabochip data produced by the CARDIoGRAM+C4D consortium representing 63,253 cases and 126,820 controls has identified 1885 SNPs passing a False Discovery Rate (FDR) threshold of 0.5%. We hypothesized that an expanded multi locus genetic risk score (GRS) incorporating genotype information at all loci below an FDR of 0.5% would perform better than a GRS restricted to 42 loci reaching genome wide significance and tested this hypothesis in subjects of European ancestry participating in the Atherosclerosis Risk in the Community (ARIC) study. Models testing the GRS were either minimally (age and sex) or fully adjusted for traditional risk factors (TRFs). The Figure shows the hazard ratio (HZ) and 95% CI for incident events comparing each quintile of GRS to the middle quintile. The GRS including genotype information at all loci with an FDR of 0.5% noticeably improves risk prediction over the GRS restricted to genome wide significant loci in both the minimally and fully adjusted models based on several metrics including i) HR per GRS quintile, ii) the HR per SD of the GRS, and iii) the logistic regression pseudo R2, and iv) the c statistic. The HR per GRS quintile and per SD of GRS were all lower in the fully adjusted models compared to the respective minimally adjusted models but the reduction of the HR was more striking for the models that tested the more expansive GRS. These findings suggest that a larger proportion of novel GWAS CAD loci are mediating their effects through TRFs. While these findings demonstrate some progress in risk prediction using GWAS loci, both the limited and the expanded GRS continues to explain a relatively small proportion of the overall variance compared to TRF. Thus, the clinical utility of a CAD GRS remains to be determined.
Plasma C-reactive protein, genetic risk score, and risk of common cancers in the Atherosclerosis Risk in Communities study
